THE AFFORDABILITY, or lack thereof, of health insurance is a national problem. But like many national problems, it is more acute in West Virginia.

The first installment of "Everybody at risk," a summer-long series that began in Sunday's newspaper, highlighted how acute the problem is here, and how much worse it may get.

Almost 300,000 working-age West Virginians don't have insurance, according to a recent survey by the West Virginia University Institute for Health Policy Research. Health-care inflation will drive the cost of insurance up even further, putting it out of reach of even more West Virginians.

"The price of health insurance will roughly double in the next five years if the cost of health care keeps going up like it has been," said Fred Holliday, an analyst for the West Virginia Insurance Commission. "It's straightforward math."

Straightforward, but frightening.

Shortly after he took office, Gov. Bob Wise instructed his department heads to work together to do something about the problem. His goal is get the number of uninsured state residents to zero. His department heads hope to get halfway to that mark in five years. They face an uphill battle.

By 2008, modest coverage for a family may reach $18,000 or more. The per capita income in West Virginia is currently $23,688. Incomes are growing at a far slower rate than health costs, and therefore insurance costs.

Most uninsured West Virginians work. They make too much to be covered by Medicaid, the state-federal program designed to provide coverage for the poor. Some parents do without insurance so they can afford it for their children.

The problem will be worse in West Virginia, and sooner, for all the usual reasons: West Virginians on average are older, poorer and have more unhealthy habits than the rest of Americans.

The United States spends twice as much per capita for health care than other developed countries do, but there is no evidence that U.S. care is any better. In fact, America is far down the list in most health indicators, such as infant mortality and average lifespan.

"The whole subject of health-care costs is maddening," said Pat White, West Virginia Health Right administrator. "We're the wealthiest country in the world, but we can't do anything as simple as providing medicine for people who need it. Seems like our priorities are backward. And the numbers just continue to grow."

Universal health care coverage provided by a single-payer system is the ultimate answer. Such systems eliminate insurance bureaucracy and cut costs. But there's little hope for this reform, as long as conservatives control Washington.

THE AFFORDABILITY, or lack thereof, of health insurance is a national problem. But like many national problems, it is more acute in West Virginia.

The first installment of "Everybody at risk," a summer-long series that began in Sunday's newspaper, highlighted how acute the problem is here, and how much worse it may get.

Almost 300,000 working-age West Virginians don't have insurance, according to a recent survey by the West Virginia University Institute for Health Policy Research. Health-care inflation will drive the cost of insurance up even further, putting it out of reach of even more West Virginians.

"The price of health insurance will roughly double in the next five years if the cost of health care keeps going up like it has been," said Fred Holliday, an analyst for the West Virginia Insurance Commission. "It's straightforward math."

Straightforward, but frightening.

Shortly after he took office, Gov. Bob Wise instructed his department heads to work together to do something about the problem. His goal is get the number of uninsured state residents to zero. His department heads hope to get halfway to that mark in five years. They face an uphill battle.

By 2008, modest coverage for a family may reach $18,000 or more. The per capita income in West Virginia is currently $23,688. Incomes are growing at a far slower rate than health costs, and therefore insurance costs.

Most uninsured West Virginians work. They make too much to be covered by Medicaid, the state-federal program designed to provide coverage for the poor. Some parents do without insurance so they can afford it for their children.

The problem will be worse in West Virginia, and sooner, for all the usual reasons: West Virginians on average are older, poorer and have more unhealthy habits than the rest of Americans.

The United States spends twice as much per capita for health care than other developed countries do, but there is no evidence that U.S. care is any better. In fact, America is far down the list in most health indicators, such as infant mortality and average lifespan.

"The whole subject of health-care costs is maddening," said Pat White, West Virginia Health Right administrator. "We're the wealthiest country in the world, but we can't do anything as simple as providing medicine for people who need it. Seems like our priorities are backward. And the numbers just continue to grow."

Universal health care coverage provided by a single-payer system is the ultimate answer. Such systems eliminate insurance bureaucracy and cut costs. But there's little hope for this reform, as long as conservatives control Washington.